User:Warwick789/sandbox

Introduction
ReSPECT is an Emergency Care and Treatment Plan (ECTP) in which personalised recommendations for future emergency clinical care and treatment are created through discussion between health care professionals and patients (or their relatives) and documented on a patient-held form. These recommendations are about cardio-pulmonary resuscitation (CPR) - attempting to re start the heart when it has suddenly stopped - as well as other emergency treatments, such as ventilation, kidney dialysis, intravenous medication, or admission to intensive care. During ReSPECT conversations health care professionals aim to find out what the patient’s preferences are regarding future treatment and care (what treatments they would want to be considered for in an emergency, and what they would not want to receive) while explaining what treatments would not work or benefit them. ReSPECT forms are not legally binding but can be used by health care professionals to guide them when providing treatment for the patient in a future emergency situation. They are designed to be transferred across different care settings, for example between hospitals, primary care, ambulance services, or care homes.

Development
ReSPECT was developed after attendees at a 2014 summit at the Royal Society of Medicine on Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in the UK criticised the variability and problematic practice linked to standalone DNACPR decisions. Development of the ReSPECT process involved a review of literature, a national consultation, interviews with healthcare professionals and members of the public, a workshop with patients and public, and a usability trial.

Usage
In the UK, 21% of hospitals had adopted ReSPECT by December 2019.4 ReSPECT is the fastest growing ECTP in the UK, as many hospitals move away from using standalone DNACPR forms.

Evaluation
An evaluation of the use of ReSPECT in hospitals in England, during the early stages of adoption, found the following:
 * Hospital-based healthcare professionals prioritised ReSPECT conversations with patients whom they identified as terminally ill or anticipated were at imminent risk of deterioration. A move towards a more holistic approach in terms of treatment recommendations and conversations was observed but there remains a focus on DNACPR as a central component of conversations.
 * Emergency care treatment planning conversations are often complex and need to draw together patients' preferences and values within a framework of clinical judgement.
 * Conversations were easier for patients, their family, and health care professionals if patients had thought about these things in advance and discussed this with their family.
 * Patients (and / or those close the patient) were involved in making most but not all emergency care treatment plans. The ReSPECT supporting materials were rarely used during decision making. Involvement of patients usually focused on asking about their preferences for specific treatments or explaining recommendations.  It was rarer for patients to be asked about their values and preferences, and for these to influence recommendations.
 * Recommendations on ReSPECT forms completed in hospital sometimes are not helpful when future decisions are made in the community.
 * ReSPECT conversations take time to do properly and so may not happen or be done well if there is limited time because of staff shortages or a busy ward environment.